Acute and Critical Care

Transport of the Mechanically Ventilated Patient: Chang Ho Kim; Korean J Crit Care Med. 2000;15(1):1-5.

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Abstract PDF: No abstract available

Hepatic Ischemia/Reperfusion Injury and Hemodynamic Changes: Dong Gun Lim, Woon Yi Baek; Korean J Crit Care Med. 2000;15(1):6-10.

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Abstract PDF: No abstract available

Effect of Elastase Inhibitor and Antioxidant on Acute Lung Injury: Jin Hong Chung; Korean J Crit Care Med. 2000;15(1):11-15.

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Adrenergic Receptors and Cardiovascular System: Jeong Seon Han; Korean J Crit Care Med. 2000;15(1):16-23.

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Perioperative Thermal Pertubation: Jin Soo Kim; Korean J Crit Care Med. 2000;15(1):24-30.

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The Comparison of Buccal SpO2 and Finger SpO2 Accuracy in Patients with Moderate Defect in Pulmonary Function Test: Mee Young Chung, Jun Seuk Chea, Chang Jae Kim, Byung Ho Lee, Seung Ho Joo; Korean J Crit Care Med. 2000;15(1):31-34.

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Abstract PDF: BACKGROUND
The reliability of pulse oxymetry probes when applied to the finger or toes may be compromised in certain patients. Other sites less subject to mechanical interference or a pathophysiologic decrease in pulse amplitude have been sought. In the patients with moderate defect (N=20) in pulmonary function test, we examined the accuracy of buccal and digital SpO2 (oxygen saturation of pulse oxymetry) monitoring.
METHODS
SpO2 probe was placed firmly in the corner of the patient's mouth. Buccal and finger SpO2 and radial SaO2 (arterial oxygen saturation) were measured before the induction of anesthesia. The agreement between SaO2 and each SpO2 were calculated with the method outlined by Bland and Altman.
RESULTS
Buccal SpO2 was higher than finger SpO2, but finger SpO2 agreed more closely with SaO2 (buccal; 97.9+/-1.89, finger; 94.5+/-2.48, radial; 93.73+/-2.73%).
CONCLUSIONS
We conclude that buccal SpO2 monitoring may offer alternative when other sites aren't available. But, we suggest that buccal SpO2 should be further evaluated for the accuracy.

Comparison of Conventional Chiron 348 pH/blood Gas/electrolytes Analyzer and i-STAT Portable Clinical Analyzer: Dong Suk Chung, Jong Bun Kim, Sie Hyun You; Korean J Crit Care Med. 2000;15(1):35-40.

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Abstract PDF: BACKGROUND
The development of so-called "Point-of-care" (POC) devices for blood or urine analysis has resulted in many systems that are widely used at home or at the bedside. We evaluated the performance of the I-STAT portable clinical analyzer for measuring blood gases (pH, PCO2, PO2) and whole blood electrolytes (sodium, potassium and ionized calcium) with reference to a conventional blood gas analyzer (Chiron 348 pH/ blood gas/electrolytes).
METHODS
Thirty samples from the arterial blood were simultaneously analyzed with I-STAT system and with Chiron 348 pH/blood gas/ electrolytes analyzer. Differences between results of two methods were analyzed by paired t-test (p<0.05).
RESULTS
PO2, PCO2 and Na measured with I-STAT system and Chiron 348 PH/ blood gas/ electrolytes analyzer showed no significant differences. pH, calculated HCO3, K and Ca measured by two methods showed significant difference, but observed differences would not affect clinical decisions except ionized calcium.
CONCLUSIONS
This study shows that blood gas and electrolyte analysis using the I-STAT portable device is comparable with that performed by a conventional Chiron 348 pH/blood gas/ electrolytes analyzer except ionized calcium.

Effect of Continuous Epidural Block on the Duration of Intensive Care after Cardiac Surgery: Choon Soo Lee, Jung Uk Han, Tae Jung Kim, Chong Kweon Chung, Hyun Kyung Lim, Young Deog Cha, Hey Ran Shin; Korean J Crit Care Med. 2000;15(1):41-46.

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Abstract PDF: BACKGROUND
Continuous epidural block after surgery has been able to get better postoperative analgesic effect than intermittent intravenous (IV) opioids and to decrease the duration of mechanical ventilatory support, endotracheal intubation and ICU stay. The purpose of this study is to observe these effects of continuous epidural block after cardiac surgery.
METHODS
30 patients, undergoing cardiac surgery, were divided into 2 groups. Postoperative analgesia were performed by intermittent IV meperidine 25 mg in group 1 and by continuous epidural block with 1% mepivacaine 100 ml and morphine 4 mg in group 2. Both groups were supplemented, at the patient's request, by IV meperidine 25 mg as needed. Quality of pain relief, total number of IV meperidine and duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay were compared between 2 groups.
RESULTS
Quality of pain relief and total number of IV meperidine were significantly lower in group 2 than group 1, each time interval. Duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay and time interval between consciousness return & mechanical ventilatory support were significantly shorter in group 2 than group 1.
CONCLUSIONS
Continuous epidural block, with 1% mepivacaine 100 ml and morphine 4 mg, for postoperative analgesia decreases the duration of intensive care compaered with intermittent IV meperidine 25 mg, after cardiac surgery.

Use of Femorofemoral Bypass for Life Saving before the Emergency Replacement of Thrombotic Prosthetic Mitral Valve: Il Woo Shin, Hyoung Chan Cho, Wan Soo Choi, Woo Chang Yang, Hyun Keun Lee, Young Kyun Chung; Korean J Crit Care Med. 2000;15(1):47-51.

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Abstract PDF: Mechanical valves have generally good hemodynamic function and indefinite durability, but they have a higher thromboembolic potential and thus a requirement for permanent anticoagulation, because thrombotic occlusion is a potentially fatal complication of heart valve replacement surgery. We had experienced mitral valve replacement because of thrombosis around the replaced prosthetic valve. The patient's mechanical prosthetic valve was acutely obstructed by thrombosis, and it was a life threatening condition. We performed partial bypass through femorofemoral bypass for life saving. Femorofemoral bypass improved oxygenation and cardiovascular stability, and mitral valve replacement was successfully performed without complication.

The Use of Thiopental Sodium with BIS Monitoring in Hypoxic Brain Damage: Jae Young Kwon, Sul Ki Song, Kyung Hoon Kim, Sang Wook Shin, Seong Wan Baik; Korean J Crit Care Med. 2000;15(1):52-55.

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Abstract PDF: Hypoxemia is a common and potentially serious postoperative complication. Hypoxic encephalopahty may occur in prolonged hypoxemia. This condition needs brain protection. There are many brain protective methods. The primary cental nervous system protective mechanism of the barbiturates is attributed to their ability to decrease the cerebral metabolic rate, thus improving the ratio of oxygen (O2) supply to O2 demand. The electroencephalogram-derived bispectral index system (BIS) is a promising new method to predict probability of recovery of consciousness. We experienced two cases of hypoxic brain damage in recovery room. The patients were treated with thiopental and monitored with BIS. The use of thiopental as brain protection during complete global ischemia after cardiac arrest was not effective.

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